Version July 2025
| Comorbidities | |
| Cancer history | |
| Yes | 1 |
| No | 0 |
| Coronary heart disease | |
| Myocardial infarction | 1 |
| Coronary artery bypass grafting | 0.75 |
| Percutaneous coronary intervention | 0.5 |
| Medication | 0.25 |
| No medication | 0 |
| Dementia | |
| Severe | 1 |
| Moderate | 0.5 |
| Mild | 0.25 |
| None | 0 |
| Daily activities | |
| Help with grooming | |
| Yes | 1 |
| No | 0 |
| Help managing money | |
| Yes | 1 |
| No | 0 |
| Help doing household work | |
| Yes | 1 |
| No | 0 |
| Help toileting | |
| Yes | 1 |
| No | 0 |
| Help walking | |
| Wheelchair | 1 |
| Walker | 0.75 |
| Cane | 0.25 |
| None | 0 |
| Health attitude | |
| Feel less useful | |
| Most time | 1 |
| Sometimes | 0.5 |
| Never | 0 |
| Feel sad | |
| Most time | 1 |
| Sometimes | 0.5 |
| Never | 0 |
| Feel effort to do everything | |
| Most time | 1 |
| Sometimes | 0.5 |
| Never | 0 |
| Falls | |
| Most time | 1 |
| Sometimes | 0.5 |
| Never | 0 |
| Feels lonely | |
| Most time | 1 |
| Sometimes | 0.5 |
| Never | 0 |
| Function – Sexually active | |
| Yes | 1 |
| No | 0 |
| Nutrition – Albumin | |
| <3 | 1 |
| >3 | 0 |
